Issuu

Canadian

HealthcareFacilities Journal of Canadian Healthcare Engineering Society

Volume 32 Issue 3

Spring/printemps 2012

The

Green Issue

PM#40063056

Inside

Conserving Water and Expenses at Guelph General Hospital Greener Means Safer...Most of the Time Cornwall Community Hospital Puts Food Waste to Good Use

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contents

Canadian Healthcare Facilities Volume 32 Number 3

Canadian Healthcare facilities IS published BY under the Patronage of the canadian healthcare engineering society Publisher

Steve McLinden e-mail: stevem@mediaedge.ca

Editor

Matthew Bradford e-mail: matthewb@mediaedge.ca

Advertising Sales

Sean Foley MediaEdge Communications 416-512-8186 e-mail: info@mediaedge.ca

departments 6 Message from the Publisher By Steve McLinden 8 Message from the President By John J. Knott 10

Call for Nominations

14 Conserving Water and Expenses at Guelph General Hospital By Allan Kelly 18 22 25

Annette Carlucci

Designer

Jennifer Carter

production Manager

Rachel Selbie

SCIss JOURNAL trimestriel publié PAR MEDIAEDGE COMMUNICATIONS INC. sous le patronage de la société canadienne d’ingénierie DES SERVICES DE SANTÉ Steve McLinden e-mail: stevem@mediaedge.ca

Éditeur

Rédatric intérimaire

Matthew Bradford e-mail: matthewb@mediaedge.ca Sean Foley

publicitaire

Chapter Reports

Articles 13

Senior Designer

MediaEdge Communications 416-512-8186 e-mail: info@mediaedge.ca Pubicité

Annette Carlucci

COORDINATEUR de production

Rachel Selbie

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

President

John J. Knott

Greener Means Safer...Most of the Time By Mike Sawchuk

VICE-PRESIDENT

Peter Whiteman

Past President

Michael Hickey

Warm Water Nurtures Airborne Hazard By Barbara Carss

treasurer

Ron Durocher

Secretary

Robert Barrs

EXECUTIVE DIRECTOR

Donna Dennison

Cornwall Community Hospital Puts Food Waste to Good Use By Brad Crepeau

CHES Conference Preview

CHES 2012 Webinar Series Schedule

Chapter Chairmen Maritime: Bill Goobie Alberta: Ken Herbert B.C.: Mitch Weimer Ontario: Allan Kelly Manitoba: Reynold Peters Newfoundland & Labrador: Randy S. Cull Founding Members H. Callan, G.S. Corbeil,

J. Cyr, S.T. Morawski Ches

4 Cataraqui Street, Suite 310 Kingston, Ontario K7K 1Z7 Telephone (613) 531-2661 Fax (613) 531-0626 e-mail: ches@eventsmgt.com CHES Home Page: www.ches.org Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530

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Publisher's Message

Green minds think alike We're well into 2012, and no doubt many of you are using these initial months to plan your respective CHES conferences. I wish you all the best in the events to come, and look forward to hearing about your successes in future issues. Once more, we've dedicated our spring edition to all things green – turning our focus to new ideas in environmental sustainability and green initiatives in the healthcare engineering field. In these pages, you'll find CHES Ontario Chair Allan Kelly's water conservation case study, “Conserving Water and Expenses at Guelph General Hospital”; as well as Mike Sawchuk's report, “Greener Means Safer...Most of the Time”, which highlights the best practices for using green cleaning products, and breaks down some of the common misconceptions about cleaning products in general. Our focus on green continues with Barbara Carss's article, “Warm Water Nutures Airborne Hazard”; and in Brad Crepeau's report, “Cornwall Community Hospital Puts Food Waste to Good Use.” As always, we've included reports from CHES Chapters across Canada, many of which speak of exciting new events, conferences, and educational programs in development. And remember, if you know of someone who is deserving of CHES' Hans Burger Award for Outstanding Contribution to Healthcare Engineering or the Wayne McLellan Award of Excellence, now is the time to make your nomination heard. While it may sometimes seem like “going green” is little more than a buzzword for marketers, it is nonetheless a very real priority for the healthcare industry, and a movement that can generate profoundly positive effects on the health and livelihood of healthcare professionals and patients alike. We hope this issue provides you some guidance in achieving environmental goals within your facility.

Steve McLinden Publisher stevem@mediaedge.ca Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor. Canadian Healthcare Facilities Magazine Rate Extra Copies (members only) $25 per issue Canadian Healthcare Facilities (non members) $30 per issue Canadian Healthcare Facilities (non members) $80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees. La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice. Prix d’achat du Journal trimestriel Exemplaires additionnels (membres seulement) 25 $ par numéro Journal trimestriel (non-membres) 30 $ par numéro Journal trimestriel (non-membres) 80 $ pour quatre numéros L’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS. 6 Canadian Healthcare Facilities

New for 2012 CHES e-news The Canadian Healthcare Engineering Society (CHES) has launched a new electronic newsletter. As a supplier to the hospital and long term care sector, you have an opportunity to reach out to every CHES member plus an additional 2,000 long term care facilities. Your advertising message will be delivered to over 3,000 inboxes with the latest in news and developments in the health care sector.

New in CHES/SCISS

January 25, 2011

Benchmarking Study The Benchmarking Study is now available online as a downloadable pdf. Members must first login and then click on Resources. Read this article > Benchmarking Study The Benchmarking Study is now available online as a downloadable pdf. Members must first login and then click on Resources. Read this article > Benchmarking Study The Benchmarking Study is now available online as a downloadable pdf. Members must first login and then click on Resources. Read this article > Benchmarking Study The Benchmarking Study is now available online as a downloadable pdf. Members must first login and then click on Resources. Read this article > Advertise in the CHES/SCISS E-News For additional information, please click here.

Call today to book your spot. CHES e-news will mail six times in 2012. Space is limited. Steve McLinden, Publisher • Tel: 866-216-0860 x239 • Local: 416-512-8186 x239 • Email: stevem@mediaedge.ca

Message from the President

Conference season heating up Spring has finally arrived and I hope everyone has come through the winter in good health! With spring comes an array of conferences hosted by many of our provincial chapters. Our CHES website (www.ches.org) has links to information on all of the upcoming conferences, so be sure to check out what your chapter is planning and take advantage of the great educational opportunities these conferences offer to our membership. The formal education sessions and networking events are what make CHES conferences a great deal for the dollars spent. Make a smart investment in your future - and that of your organization - by taking advantage of these educational offerings. I mentioned in my previous report that former CHES President Steve Rees has agreed to continue his work with ASHE and IFMA on the setting of benchmark standards for healthcare facilities. Benchmark surveys are due to be released on April 1, 2012, with completed surveys due back on October 1, 2012. As with any benchmark survey, the final results will depend on the number of survey responses received. In order to make this survey successful, and to build a very informative statistical database that can be used by all Canadian healthcare facilities going forward, I believe it is important for each of us to fill out and return the information requested. If we all work together on this I think we will be amazed at the results. I also want to remind CHES members of the webinar series being offered to our membership through the Professional Development Committee. This year’s series of four webinars includes some very interesting topics. If you missed the March webinar on Bill C-45, there is still the April webinar on Firestopping, the October session on Energy Management, and the November program on the New Medical Gas Standard. Don’t miss these chances to educate you and your staff through this innovative learning initiative. It is also that time of year to be thinking about submissions for the Hans Burgers Award for Outstanding Contribution to Healthcare Engineering and the Wayne McLellan Award of Excellence. Everyone knows of someone who deserves to be honoured and runners-up also receive recognition just by being nominated and by someone showing their appreciation for what they do. So let’s get those nominations in for consideration. Lastly, I would be remiss if I didn’t mention the upcoming National Conference in Montreal this September. Details and registration materials can be found on our CHES website. You won’t want to miss this exciting venue and the thought provoking educational sessions. I would also like to send out heartfelt condolences from all of the CHES membership to Ron Durocher, our national treasurer, for the loss of his wife, Bonnie, this February.

John J. Knott, CET, HMT, CEM

8 Canadian Healthcare Facilities

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The Maritime Chapter of CHES has established a bursary, which is open to all immediate family members of active chapter members. To facilitate this, a Bursary Subcommittee of the Maritime Chapter was established consisting of the past chair of the Maritime Chapter Executive, as well as a representative from each of the three provinces (NB, NS, and PEI) making up the CHES Maritime Chapter. Each year, the bursary sub-committee will recommend who the successful candidate is to the Chapter Executive, based on a set of criteria and the amount of bursary available to be given out depending upon the chapter’s fiscal state. The chapter has set aside funds in a bursary account, where the principal amount will be maintained yearly. The initial bursary will be $1000 per year, and will be presented to the successful applicant at the Maritime Chapter Annual Conference and Tradeshow, held in May of each year. When the CHES National Conference and Tradeshow is held in the Maritimes, it will presented at that time. If any chapter wishes to obtain further information on how this bursary is structured, please feel free to contact Ralph Mayfield, Chair of the Bursary Subcommittee.

ONTARIO CHAPTER REPORT

Per E. Paasche Maritime Chapter Communication Representative

Planning is well underway for the CHES Ontario Conference in Kingston, Ontario, on June 3-5. Chris and his team are doing a terrific job on organizing the event. We have a great program planned and I am looking forward to seeing many of our Ontario members. If you haven’t registered, there is still time. As an added bonus, some lucky delegate at the conference will win an all-expense paid trip for two to the 2012 CHES National Convention in Montreal. CHES Ontario continues to work with the Canadian Coalition for Green Healthcare and the proposals for the OHA. This is a work in progress, but if we achieve what we set out to do there will be great benefits for all hospitals in Ontario. Orland Hartford had the pleasure of presenting one of our students with an award. The award ceremony took place at Fanshawe College's St. Thomas campus. CHES Ontario is very proud to be participating in these events and contributing to the success of future leaders in the healthcare industry. CHES is investigating establishing a bursary for our members’ children who are going to college or university. When we have this finalized, we will share this information with all of our members. CHES is participating in the Ontario Long Term Association Conference and Trade Show, running April 1 – 3 in Toronto. Through this show, we hope to show the value of CHES to our long term care associates and hopefully encourage these associates to join CHES. I would like to welcome Richard White from Hôtel-Dieu Grace Hospital in Windsor and Allen Lyte from Halsall. Richard has agreed to represent Ontario on the Partnerships and Advocacy Committee, which I sit on as chair, and Allen has agreed to represent Ontario on the Communications Committee. I would also like to thank Kevin Day, our former Ontario representative for the Communications Committee, who has resigned from our executive to pursue a career in the public sector. Kevin has been instrumental in helping bring CHES Ontario in to the social media front. I hope everyone is enjoying the spring time twice over - since we never did received any winter season - and I look forward to seeing all of you at the conference in Kingston. Allan Kelly Ontario Chapter Chair

10 Canadian Healthcare Facilities

MANITOBA CHAPTER REPORT

MARITIME CHAPTER CHAIR

Chapter Reports With April 25, 2012 fast approaching, the MB Chapter Education day planning is well underway, with Fire & Life Safety Systems being the days topic. By now, all MB members should have received a copy of the registration information. They are urged to submit their registration as soon as possible. Some highlights of this year's MB Education Day include Fire Life Safety - Code Enforcement Overview, Applying Codes in Existing Facilities/Assessments, Testing Fire Suppression Systems, Fire Stopping and Testing of Fire Dampers & Smoke Control, Role of the Fire Marshall/Purpose/ Contents of Fire Plans, and Fire Alarm testing. We continue to experience challenges in maintaining both a treasurer and secretary positions at the executive level. Tom Still, our current treasurer, has taken on a new position as a project manager with SNC - Lavalin O & M after a number of years working at the Seven Oaks Hospital in Winnipeg. Tom will stay on as the treasurer until our education day in April, where we will be electing both a new treasurer and secretary for the MB Chapter, and discussing some proposed amendments to our by-laws. I would like to thank Tom at this time for all his hard work over the years with CHES on the executive, and I wish him well in the future. Tom is planning to continue with CHES as a associate member with his new job and we look forward to his continued involvement with the MB Chapter. If you are interested in becoming a member of the MB Chapter Executive, or you haven't received the registration info for the education day, please feel free to contact myself or Craig Doerksen and join us in bringing new aspects and idea's to the MB Chapter. Reynold J. Peters Manitoba Chapter Chair

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ALBERTA CHAPTER REPORT

BC CHAPTER REPORT

Chapter Reports As I write this, the CHES BC 2012 Conference in Penticton, running June 3-5, is the topic of the day for most of your CHES BC Executive. It’s a labour of love for many of us, and takes up a considerable amount of time planning and organizing it each year. I would like to pass out a special thanks to our 2012 Conference Planning Committee which consists of Steve McEwan (chair), Sarah Thorne, Steve McTaggart, Gary Sveinson, Norbert Fischer, Mark Swain, and – last but definitely not least – Wendy MacNicoll. The conference is rounding into form very nicely. The call for education abstracts has just closed and the conference education committee is diligently wading through all of the applications. The education program is taking shape fast and shows excellent promise. We’ve just kicked off our first ever online registration program for both delegates and exhibitors at CHES.org. The registrations are already flooding in.

Your BC Conference Organizing Committee is now hard at work sorting out the many small tasks that go into planning a significant conference such as ours. Here’s a fact: I get quite a few comments and suggestion regarding where we should hold the conference. Sorry to say, but Vegas and Kelowna are out. The CHES BC Conference has been so successful in the last few years that our growth has now limited us to only a handful of locations in BC which can host a conference of our size. By the time you read this, your BC executive will have held its fourth executive meeting on Feb 17 in Vancouver to continue working out the details of our strategic agenda for 2012. Some of the topics for our meeting include Education Programming, Membership Drive, Upcoming Elections, CSA Codes and Standards and – if I haven't mentioned it enough already – the 2012 BC Conference.

The Alberta Chapter is gearing up to conduct and host a number of activities this year, which include: March: Site tour/meeting of the new Fort Saskatchewan Hospital (Date TBD) April : Healthcare Construction Certificate Course in Edmonton (April 19-20) June : Education Day in Red Deer (June 8)

Sept: Site tour/meeting of the new Calgary South Health Campus (Sept. 14) Nov: Clarence White Conference and Trade Show and the AGM (Nov. 5-6 in Red Deer) Also, this is an election year for the Alberta Chapter. Our vice chair, Preston Kostura, will be moving into

A reminder: the CHES BC Education committee has been diligently working to develop some exciting new member education programs. CHES BC members are open to apply for our personal education sponsorship program, which this year has increased to a maximum of ten applicants at $1000 per person, and is open to all CHES BC members. CHES BC has also increased both the quantity and types of education programs that will be supported for 2011/12. The Education Committee has been hard at work developing this program for an upcoming release. As part of this program, CHES BC has set aside $18,000 of targeted funding for BC’s six health authorities to secure education related to the operations, maintenance and construction of healthcare facilities. Mitch Weimer BC Chapter Chair

the chair position and I will be moving into the past chair. Watch for the call for nominations via the CHES web page for the following positions: vice chair, secretary, and treasurer. Ken Herbert Alberta Chapter Chair

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Award Nominations

CALL FOR NOMINATIONS FOR AWARDS 2012 Hans Burgers Award For Outstanding Contribution to Healthcare Engineering

2012 Wayne McLellan Award of Excellence In Healthcare Facilities Management DEADLINE: March 31, 2012

DEADLINE: March 31, 2012 To nominate: • Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

To nominate: • Please use the nomination form posted on the CHES website and refer to the Terms of Reference. Purpose The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.

Purpose • To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program, environmental stewardship program, or team building exercise. Award sponsored by

For nomination forms, terms of reference, criteria, and past winners, visit: www.ches.org / About CHES / Awards Send nominations to: CHES National Office • ches@eventsmgt.com • Fax: 613-531-0626

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Spring/printemps 2012 13 Untitled-1 1

12-03-05 10:08 AM

Conserving Water and Expenses at Guelph General Hospital By Allan Kelly

14 Canadian Healthcare Facilities

Guelph General Hospital (GGH) is a comprehensive acute care facility servicing a population of 180,000 people throughout Guelph and Wellington County. The hospital provides 165 beds and consists of a total floor area of 340,000 square feet plus a medical office building measuring a total area of 32,000 square feet. In 2006 GGH entered into an energy agreement with Johnson Controls. The energy performance contract had a payback of 3 years, with savings guaranteed at over $150,000 per year. Savings were generated through a reduction in electricity and gas. Later, in 2011, GGH retained Enviro-Stewards Inc. to complete a water conservation assessment funded under the City of Guelph’s water conservation program. The scope of this water audit consisted of an assessment of historical data, staff interviews, and in-plant studies to determine where water was being consumed in the daily operations of GGH. Results of the in-plant studies were used to generate a water balance for the facility, which is summarized in the accompanying table which is summarized in Table 1. Based on the in-plant studies, potential reduction opportunities were identified. Water consumption, when expressed in terms of water intensity (m3/m2/year.), can be compared to industry benchmarks to gage the performance of the hospital with respect to water consumption. Benchmarks sited for Ontario

Changing from a once through unit to an air cooled unit for this bio-hazardous fridge saved $13,000 per year

A defective solenoid valve in the kitchen was replaced and paid for itself in three months

“Our ongoing plans for energy efficiency is just that – we plan to make energy a permanent part of the hospitals educative role.” Spring/printemps 2012 15

Table 1: Water Balance

Source

m3/day

m3/year

percent

Domestic, Sterilizers, Dishwasher

111.0

40515

37.900

Once Through Cooling

43.0

15695

14.700

Hot Water Make-up

42.7

15586

14.600

Cooling Tower

35.4

12921

12.100

Dialysis RO

21.1

7702

7.200

RO retentate

13.2

4809

4.500

RO to boiler

9.4

3422

3.200

Fluid cooler

11.7

3079

2.900

RO to other processes

3.8

1387

1.300

Kitchen (soak,Salvajar)

1.8

657

0.600

Other

3.1

1137

1.100

Total

296.2

106909

100%

Table 2: Water Consumption 2009 Water Consumption

m2/yr

107510

Total Area

m/2

34560

GGH Water Intensity

m/3m2/yr.

3.11

Hospital Benchmark

m3/m2/yr.

3.57

Percentage of Benchmark

Repiping the compressor will save the hospital $34,000 per year

16 Canadian Healthcare Facilities

87%

hospitals are based on a study completed for the Ontario Hospital association in 2006. Identifying water consumption The hospital benchmark referenced in the adjacent table 2 demonstrates average annual consumption per m2 of Ontario community hospitals surveyed for the fiscal year 2004/2005. As shown, the water intensity in 2009 was approximately 13% less than the benchmark. Based on the analysis, it was found that total water consumption is not correlated with the outdoor temperature, suggesting the variability is a result of internal processes. Domestic water use – i.e sterilizers, dishwasher, once-through cooling water, hot water make-up and cooling tower make-up – accounted for nearly 80% of the total water consumption. The single largest water con su m i n g pro ce s s , a cco u n t i n g for approximately 15% of the total, was the oncethrough cooling water required to cool the refrigeration compressors. The processes consuming the remaining 20% of water were reverse osmosis (RO) water used for dialysis, RO retentate, boiler make-up (RO water), fluid cooler make-up, RO water for SPD final rinse and other processes, and the kitchen soak and Salvajar. To explain, once-through cooling water is used to remove excess heat from refrigeration unit 2. A solenoid valve opens when the compressors turn on, allowing city water to flow and remove heat from the system. A clamp-on ultrasonic flow meter measured the instantaneous flow rate at approximately 77 litres per minute. A motor logger monitoring the compressor for seven days determined that the compressors operate approximately 39% of the time. Assuming this was representative of normal operating conditions, approximately 43 m3/day (as an average) and 15,700 m3/year. (15% of total) of city water is discharged to drain as a result of once-through cooling water. Hot water is supplied to the hospital at two temperatures: domestic hot water (DHW) at 122F at the patient outlet, and sterile processing department (SPD) hot water at 144F. Tankless steam hot water heaters maintain a set temperature for the hot water loops. As hot water is consumed, cold make-up water is supplied to the hot water system. A clamp-on ultrasonic flow meter logged the hot water consumption for a one week period. Daily consumption averaged 43m3/day over a one week period. Based on this, the annual hot water consumption was estimated at 15,700 m3/year (14.6% of total).

Two centrifugal chillers provide cooling during the summer months. Heat is removed from the chillers using a cooling tower. Hospital records indicated the annual cooling tower make-up was 12,900m3/year (12% of total). The main cooling tower is drained during winter months, during which time a fluid cooler is used to remove excess heat from the building. Hospital records indicate the make-up to the fluid cooler is almost 3,100 m3/year (3% of total). RO water treatment process is used to generate RO water. RO water is generated in the power plant and the Dialysis department. The primary RO system generates a total of approximately 4800 m3/year which is used for boiler make-up and SPD final rinse water. For every litre of RO water produced, an equal amount of reject water is discharged to drain. RO produced water and reject water together account for about 16% of the total water consumption.

approximately 4,068m3/year, and $9000 per year. Replacing the valve had a payback of just one month. A bio-hazard fridge located in the tunnel of the 73 Delhi building had a oncethrough cooling unit that had a similar operation as the compressor #2 for the fridge. The cooling unit was changed to an air cooled model because of the run to the chilled water line it was not practical to tie into the cooling system. Changing from a once-through to an air cooled system saved 6,079 m3/year, saved the hospital $13,000 per year, and had a payback of two months. Our ongoing plans for energy efficiency is just that – we plan to make energy a permanent part of the hospitals educative role. This project has allowed us to save considerable sums of money, which can be put to better use elsewhere in the hospital. Guelph General Hospital has been and will continue to be a leader in its community, and an innovator on all fronts.

Water conservation opportunities The total quantified potential water savings was estimated at approximately 20,000 m3/ year with estimated dollar savings of over $45,000/year Building staff found an additional $13,000 in savings related to oncethrough domestic water cooling. Excess heat from refrigeration unit 2 Is currently removed using once-thru cooling water. Piping for the fluid cooler closedloop system is located in the same room as the refrigeration equipment requiring once-thru cooling. This close proximity would allow re-piping to provide cooling from the fluid cooler closed-loop system. This is a work in progress and the water savings is estimated at 15,666 m3/year – amounting to a dollar savings of $34,466 per year, with a $5000 investment amounts to a payback of seven months. The Salvajar, located in the kitchen, is used to remove food waste from plates and trays. A valve supplies a continuous supply of hot water to the Salvajar during operation. The flow is normally controlled by a solenoid valve. It was observed that this valve had failed, resulting in continuous flow that can only be interrupted using manual control. Replacing the valve amounted to a savings of 512m3/year, and $1100 per year. The cost to repair the unit yielded less than a two month payback. A failed solenoid valve on the Culligan RO Unit and a leaking valve on Unit B together resulted in a water loss of

Engineered Solutions Sustainable Designs Mechanical Electrical Energy Audits LEED

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Greener Means Safer…Most of the Time By Mike Sawchuk Although many cleaning experts have been advocating the use of green and safer cleaning products for nearly two decades, only in the past five or six years have there been studies available to indicate why this is so important. For instance, one study by the U.S. Environmental Protection Agency (EPA) found that everyone carries with them more than 700 contaminants; many from conventional cleaning chemicals. Although some of these are benign, and others are known to be hazardous, most have simply not been studied thoroughly enough to determine their long-term impact on people. The Barcelona (Spain) Municipal Institute of Medical Research found that female cleaning professionals had more than twice the rate of respiratory problems compared to non-cleaning workers, mostly as a result of using conventional cleaning products. Furthermore, the Canadian Lung Association identified conventional cleaning chemicals as a trigger for asthmatics and the cause of other respiratory problems. According to the association, this can be blamed primarily on the fact that many conventional cleaning products have high levels of VOCs (volatile organic

compounds), which are frequently associated with respiratory and other health related ailments. Many facility managers believe we can put these concerns aside now that green cleaning chemicals are available, have proven their performance effectiveness, and have become cost comparable to traditional cleaning products. However, this is not always the case. Even green cleaning products can be hazardous, and there have been incidents where users or building occupants have had reactions – or even injuries - using these products. Remember: just like the conventional products they were designed to replace, green cleaning products are still engineered to loosen, dissolve, and help remove soils and contaminants from surfaces. The ingredients that help them do this can be powerful and, if improperly used, harmful to the user. Because of this, it is important for managers to realize that while green cleaning products are proven safer than conventional products, they are still not 100-percent safe. The products must still be used according to the manufacturer’s recommendations, especially when it comes to dilution ratios and personal

protection. Further, cleaning workers must be taught how to properly use and store these products; and this is especially true when using disinfectants. Canadian green disinfectants Although the EPA forbids manufacturers to market or indicate their disinfectants are green, many such products have been certified in Canada, where it is permissible. Canada’s EcoLogo program, for example, has evaluated and certified many disinfectants as env ironmentally preferable. To earn this certification, the disinfectant - just like other cleaning products - must be tested and evaluated to determine if it has been made from ingredients that have a significantly reduced impact on health and the environment. Unfortunately, some healthcare managers and administrators may be under the assumption that just because the disinfectant is green, it is safe. In reality, disinfectants are very powerful cleaning chemicals, and must be used properly to disinfect as per the kill claims on the label. As to their safety, it's important to emphasize that green disinfectants are safer (a relative term), but Spring/printemps 2012 19

“Remember: just like the conventional products they were designed to replace, green cleaning products are still engineered to loosen, dissolve, and help remove soils and contaminants from surfaces.” not 100-percent safe because they are designed to kill pathogens. Because of this, cleaning staff must adhere to certain “best practices” when using disinfectants - green or otherwise - to ensure their own health and safety, that of doctors and patients, as well as that of the environment. Those best practices include: • Use disinfectants only where and when needed. What we frequently see occurring in medical locations is that cleaning professionals begin to use disinfectants for many if not most of their cleaning duties. Often this happens for no other reason than the disinfectant is handy and attached to their work cart. Administrators should try to ensure disinfectants are used in those areas and those areas only, not throughout the facility unless there is a breakout of a specific pathogen. • Clean first, then disinfect. Practice good cleaning; that is, the use of proper products (not a neutral or light duty cleaner), procedures, frequencies, tools and equipment. While proper cleaning does not kill pathogens, it removes them and leaves the surface cleaner and healthier. Another common misuse of disinfectants is to assume they both clean and disinfect surfaces all at the same time. While some disinfectants are indeed designed to do both (clean and disinfect), a surface must be cleaned first to remove soils, and then the product must be re-applied to allowed it to sit wet (dwell) for the stated time in order to kill the stated pathogens that might be present on a surface. This is a three-step process: clean, reapply, let dwell/stay wet. • Select safer disinfectants. While different window cleaners, for instance, may be similar in terms of ingredients and how they are made, this is not true of disinfectants. Some disinfectants are safer for the user and the environment because they are non-alkaline, have a neutral pH, or contain no NPEs (nonethoxylates). NPEs have the potential to be acutely and chronically toxic, and if they enter waterways, they can be very harmful to aquatic life. • The fewer VOCs, the better. As mentioned earlier, VOCs can cause a variety of health-related problems. When it comes to disinfectants - green or conventional - some manufacturers have developed effective disinfectants that have fewer VOCs. • Select disinfectants based on “kill claims.” To use disinfectants both effectively and sparingly, select them based on the kill claims noted on the product’s label. This ensures the disinfectant is designed to kill the specific pathogens of concern in your facility. Ensure the 20 Canadian Healthcare Facilities

pathogens of concern are listed on the label, and then select products “approved for hospital use” and with the broadest kill claims. • Select products with high PPMs (parts per million of actives). Quality disinfectants should have a PPM of greater than 600. Effective cleaning systems Another way to help ensure that disinfectants and all cleaning products (conventional or green) are used effectively and safely is to ensure an effective cleaning program is in place. Along with learning a lot more in recent years as to why green cleaning products are necessary, the industry has also learned a lot more on cleaning methodologies, indicating which systems and procedures tend to be most effective. For instance, studies now indicate that indoor pressure washing systems (often called no-touch cleaning systems) can prove very effective at removing soils and contaminants from surfaces with only moderate amounts of cleaning chemicals. Likewise, other studies indicate that the use of microfiber cleaning cloths and mops produce more effective cleaning results than traditional mops and cleaning cloths. Lastly, limit spraying of disinfectants; instead, pour onto the cloth, use a two bucket system with cloths, or other similar methods. A final precaution to help promote safety is to ensure the proper dilution of cleaning chemicals. The days of manually mixing chemicals are long gone. Manual dilution can often result in spills that cause injury, or result in over or under dilution. As part of a green cleaning program, most facilities now use autodilution systems that mix chemicals automatically. Not only does this help promote safety by avoiding spills, but the dilution ratio is much more accurate, resulting in less chemical waste. All of the suggestions here are designed to make cleaning sa fer. Whe t her usin g g re en cle anin g pro duc ts or conventional, administrators must always remember that, first and foremost, cleaning products must be used properly so that they are safe to use, safe for staff and patients, and safe for the environment. Mike Sawchuk has been involved with the green and professional cleaning industries for more than 15 years. He is currently Vice President and General M a n a g e r o f E n v i r o - S o l u t i o n s, a l e a d i n g manufacturer of proven-Green cleaning chemicals based in Ontario, Canada.

Warm Water Nurtures Airborne Hazard Mixed Regulatory Signals Complicate Legionella Control By Barbara Carss Regulators are increasingly targeting cooling towers in an effort to arrest t h e s o u r c e a n d p ro p a g a t i o n o f legionella bacteria responsible for serious and sometimes fatal lung infections. At the same time, they face some conflicting pressure to revise longstanding controls on a more co m m o n h o s t to l e g i o n e l l a – a building’s potable water system. Legionella moves throughout a building when it is aerosolized. That is, carried in very fine water droplets that humans can inhale. Thus, cooling towers, shower/bath fixtures, saunas, hot tubs and decorative fountains are particularly suited to transmit the bacteria, but it can also flourish and spread in other piping networks, even 22 Canadian Healthcare Facilities

cold water supply when it warms to temperatures greater than 20° C (68° F). Building managers/operators should particularly watch for so-called dead legs, which are sections of pipe where water sits unmoving for days at a time. A water pressure differential can draw that stagnant water into the potable supply, carrying contamination with it. “Risk management should really be done proactively with respect to water systems,” advises Bernard Siedlecki, Senior Associate, Indoor Air Quality & Microbial Contamination, with the consulting firm, Pinchin Environmental Ltd. “Time and time again, we get involved when people are in reactive mode. They should be aware that in the event of an outbreak, or even one

infection, they will be subject to scrutiny from Public Health and possibly from the Ministry of Labour.” The Canadian Commission on Building and Fire Codes recently released proposed changes to the National Building Code that would: impose minimum distances between cooling towers and a building’s air intake and exhaust vents; mandate backflow prevention devices and other drainage controls; reference ASHRAE guidelines for reducing legionella risks; and require access ports, service platforms and fixed ladders to provide ready access for inspection, monitoring and testing of cooling towers. The proposals, which were open for public comment until December 16,

2011, respond to outbreaks of legionellosis in recent years that were traced to mist dispersed from cooling towers. Designers, developers, building owners/managers and local building officials have expressed a need for formal guidance in identifying and mitigating risks. “That’s how changes come about. Somebody says: we need to do something about this,” reflects Diane Green, Technical Advisor for HVAC and Plumbing with the Canadian Codes Centre at the National Research Council. “If these changes are approved and adopted by the Provinces and Territories then there will be regulations.” Building owners/managers in the City of Hamilton must already comply with North America’s first municipal by-law aimed at cooling towers, which requires owners to register their cooling towers and develop risk management plans. The by-law references an Australian standard along with guidance documents from ASHRAE and the Co oling Technology Institute.

so that hot water can be stored at a temperature lethal to legionella – conventionally, 60° C (140° F) – then diluted with colder water as it moves from the storage tank to outward delivery points. In contrast, many of the older facilities captured under Ontario’s 2010 long-term care homes regulation do not have this plumbing flexibility so building operators are forced to lower storage tank temperatures in order to meet the requirement. Contradictor y adv ice abounds. Notably, the proposed new ASHRAE Standard 188, Prevention of Legionellosis Associated with Building Water Systems, recommends that hot water be stored at temperatures no less than 60° C and circulated at a minimum of 51° C (124° F) in health care facilities, nursing homes and other building facilities classified as high-risk. The Building Owners and Managers Association (BOMA) of Canada’s BOMA BESt environmental performance benchmarking program currently recommends a hot water

distribution temperature between 50° and 55° C (122° to 131° F). In 2007, developers of Canada’s National Plumbing Code withdrew a proposal for a 49° C maximum circulating temperature following largely negative response in the associated public consultation. Even so, the NPC proposal stipulated a hot water storage temperature of 60° C. Knowledgeable insiders worry that some building managers/operators are either uninformed or too lackadaisical about the appropriate temperature setting for storage tanks, particularly when they are looking for ways to reduce energy costs. “ Tu r n i n g d o w n h o t w a t e r temperatures, especially at night, or installing timers on circulating pumps is widely accepted,” reports Brad Arnold, President of the plumbing services firm, Bradley Mechanical. “I have always vigorously fought this suggestion from managers, superintendents or energy providers. There has to be an education program

Temperature tempest Me a nw h i l e , d o m e s t i c h o t w a te r presents a health and safety conundrum. Risk mitigation can create a competing risk, and safety advocates with differing priorities continue to debate the appropriate water temperature to best safeguard building occupants. Proponents of lower hot water temperatures to prevent scalding appear to have won the argument in Ontario, where two key regulations dictate a maximum temperature of 49° C (120° F) for water distribution. Critics counter that the Ontario Building Code (OBC) and the Long-Term Care Homes Act now enshrine conditions that enable legionella to thrive. “That really puts us in a bind,” observes JJ Knott, President of the Canadian Healthcare Engineering Society (CHES) and Director of Maintenance at the Norfolk General Hospital and its associated long-term care facilities in southwestern Ontario. “Legionella grows in temperature ranges up to 50° C.” New construction complying with the OBC typically incorporates mixing valves Spring/printemps 2012 23 Untitled-3 1

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Competing interests necessitate vigilance JJ Knott relies on v ig ilance and preventative measures to deal with the dilemma of Ontario’s rules. “We test our systems, as do most health care facilities, on a regular basis. That includes our cooling tower and our domestic hot water system,” he says. “We are careful not to use aerators. Those are places where legionella can make a nice home for itself.” There are also chemical-based options for destroying the bacteria. Indeed, this is the approach that various standards and guidelines recommend in vulnerable areas where proactive precautions are required and/or to remediate contaminated systems. This must be done cautiously, however, since biocides can also be aerosolized and harmful to human and environmental health. “It’s not the preferred option to treat water systems with chemicals,” Knott asserts. Commercial building operators might assume there are fewer risks in their washrooms, which typically do not feature showers or bathtubs where water is more likely to be aerosolized. Ho w e v e r, e l e c t r o n i c h a n d s - f r e e faucets, which are increasingly being a d o p t e d a s a w a t e r- c o n s e r v i n g measure, could introduce a new risk factor. Water supply to the basins is typically lukewarm, while the fixtures’ more complex inner workings can hold water for sustained periods. In the United States, administrators at John Hopkins University Hospital were recently prompted to remove electroniceye faucets and replace them with manual models after researchers found a higher level of bacteria, including legionella, within the hands-free fixtures. An associated report from John Hopkins recommends that manufacturers pursue design improvements so that more facilities could assuredly capitalize on water-saving technology. Ontario’s new Water Opportunities and Water Conservation Act includes

an amendment to the Building Code Ac t requir ing a re v iew of water conservation standards at five-year intervals. This could be a way to ensure t h a t w a te r- s av i n g te c h n o l o g y i s recognized as it becomes available, but it brings new potentially contradictory objectives to a crowded field of considerations for code developers. National code developers are also contemplating broadening the scope. “Two of the National Plumbing Code’s objectives are health and safety. It does not, at this time, have an objective for water efficiency,” Diane Green says. “But we are very much aware that there can be competing interests.” National code developers are also watching for the official release of the ASHRAE 188 standard. Standards that set out best practices tend to be reference d in the app endices of construction codes as additional information, or in relation to specialized occupancies where a level of performance above the minimum building code standard is mandated, but Green reiterates that nothing will be decided until the standard is actually finalized and available. Even so, Siedlecki notes that there is the potential for any acknowledged best practices standard to come into play in the event of an outbreak and follow-up litigation. Investigators and/or lawyers for a plaintiff could argue that building owners/managers should have reasonably been aware of the standard. “The document [standard] by itself is not a regulation, but it could be referenced by the Ministry of Labour, for ex a m p l e ,” h e ex p l a i n s . “ T h e Minist r y of Labour does have a bulletin reminding employers of their obligations under the Occupational Health and Safety Act and it does specifically talk about legionella.” For more information about proposed changes to the National Building Code, see the web site at www.nationalcodes. ca/eng/public_review/2011/introduction. shtml. For more information about the proposed ASHRAE 188 standard, see the web site at www.ashrae.org. The preceding article is reprinted from Canadian Property Management, November 2011.

Cornwall Community Hospital Puts Food Waste to Good Use Food Cycler installation creates green savings By Brad Crepeau

Welcome to the new age of recycling; a process that can play a huge role in reducing a hospital’s overall carbon footprint, and perhaps the most important step one can take in the transformation to a green healthcare facility. This was demonstrated by the Cornwall Community Hospital's (CCH) Green Team which underwent initiatives that quite possibly opened the door to otherwise unchartered waters in the world of hospital recycling. Recently, CCH identified a common problem after a kitchen waste audit showed between 150lbs and 250lbs of food waste was being tossed into its waste bins each day. The audit identified that approximately 75% of the kitchen’s total waste could be attributed to food waste, and such waste could also be blamed for the foul odours and leeching commonly associated with a kitchen dumpster. Acknowledging this, the CCH Green Team set out to find a new solution to this common problem. Enter: The Food Cycler -250, a system that now processes their entire organic Spring/printemps 2012 25

waste load on-site and inside a 15-hour window. Provided by the Canadian company Food Cycle Science, the Food Cycler system utilizes a multi-stage heating and dehydration cycle, wherein the original waste load is reduced by 90%, with no enzymes, woodchips, venting, or additional water required. Essentially, the technology uses many of the same principles of old fashioned composting, but puts it on fast-forward. As for the remaining 10%, that by-product is a sterile bio-mass that can be classified as a viable soil amendment. Many staffers are eager to use the by-product for personal use; however the opportunity for re-use throughout hospital grounds also exists. The logistics of the operation are quite simple. The machine is stationed in the dishwashing room where, throughout the day, staff simply scrape leftover food waste into small bins that are then dumped into the FoodCyler. After the last dinner service, the machine is turned on and left to operate throughout the night. In the morning, the by-product automatically discharges and the process is repeated. With the technology now its third month of operation, the hospital has seen their weekly garbage pickups drop from five times per week to a manageable once-a-week pickup. Based on the local hauling costs, it is estimated the hospital will save $6000 to $7000 per year. With local landfills nearing capacity, and the costs for hauling on the rise, this number is sure to increase going forward.

PARTNERS IN WELL-BEING research | innovation | sustainability | delivery

CCH's Food Cycler makes short work of food waste

HEALTHCARE DESIGN LEADERS Integrated architects, engineers, interior designers, urban designers and planners. Delivering forward thinking, patient-centred, evidence based healthcare solutions for over 25 years. www.designdialog.ca 26 Canadian Healthcare Facilities Untitled-8 1

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facilities may soon find The project, originally themselves forced to change spearheaded by Alan Greig, their kitchen processes. The Chief Planning and unique advantage to the Resources Officer, received C C H ’s t e c h n o l o g i c a l widespread support by the s o lut i on e l i m i n a te s t h e board of directors. With all need for these additional costs considered, the CCH trucks to be on the road. expects to realize a full Amidst the current return on their investment redevelopment of the CCH, inside of four years. it has found time to become Based on the waste audit, a pioneer. It is the first and throug h the use of hospital in Canada to have c u r re n t te ch n o l o g y, t h e the state-of-the-art Food CCH will also successfully C y c l e r t e c h n o l ogy divert 40+ metric tonnes of CCH staff and Green Team stand by their green initiatives f u n c t i o n i n g i n the food waste from landfills in workplace. Introducing new this year alone. What is technology to an outdated of ten over l o o ke d i s t h e process has saved the CCH reduction in methane gasses both time and money in a place where funds are at a that would otherwise be emitted into the atmosphere, and premium, and it is just one of many steps taken by the the fact that methane gas is 20 to 25 times more harmful to our environment than the CO2 emissions from our vehicles. CCH to go green and make more environmentally conscious decisions. Fighting for the cause, the CCH The need for businesses to find alternative solutions for their organic waste may happen sooner than one may think. Green Team is active in its continued effort to preserve our planet’s health. In Nanaimo, BC, landfills no longer accept organic waste from commercial establishments. Organics must be diverted and hauled away separately to an off-site composting Brad Crepeau is vice-president of sales and marketing for Food facility. With the green trend moving east, many more Cycle Sciences (www.nofoodwaste.com).

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Sustainable Design Lighting and Power Communications & Security High Voltage Energy Management

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32nd Annual Conference of the Canadian Healthcare Engineering Society

September 23-25, 2012 Palais des congrés, Montréal QC

Towards World Class Healthcare

Track Track 1 Track 2

Larry Smith was summoned to the Canadian Senate in 2010. He is one of the most recognized figures in the Quebec community, as President and CEO of the Montreal Alouettes for 12 seasons, star fullback for 8 years, and Commissioner of the Canadian Football League for 5 years. Senator Smith has received numerous honours during his business and football careers, has a wealth of business experience, and a powerful ability to communicate in both official languages.

Wilton Moran, Project Engineer, Copper Development Association, New York NY Track 4

Performance énergétique de l’hôpital du futur

Alan Roles, P.Eng., MBA, VP Capital Management – Calgary Zone, Alberta Health Services, Calgary AB Marc Kadziolka, P.Eng., Wiebe Forest Engineering, Calgary AB CSA Z1600 Energy Management

Gilles Desmaraisr, ingénieur, Directeur Expertise, Dessau, Laval QC Track 5

Commissioning Coordinator (Retired)

Monitoring Based Commissioning as a Tool for Evaluating and Optimizing Energy Performance of the LEED Certified Buildings

CHUM An Integrated Design Approach for a New, State-of-the-Art Healthcare Facility

Boban Ratkovich M.Sc, P.Eng, CEM, BESA, LEED AP ID+C, President, CES Engineering Ltd., Burnaby BC

Andrew King, MRAIC, Design Principal, Cannon Design, Montréal QC

ThomasMartin, B.Sc, EIT, LEED AP BD+C, Building Energy Analyst, CES Engineering Ltd., Burnaby BC

The Mitchell Partnership

The course outlines the need for a holistic approach required in the complete commission process from pre-design to post occupancy of the facility and address the need to provide the capability of ongoing and re-commissioning of the facility in the future or retro-commissioning of existing facilities.

Jessica Fullerton, M.Sc, Infection Control Practitioner, University Health Network, Toronto ON

Norma McCormack, Founder & Principal, Corporate Health Nichols Laurier, ingénieur, Vice-Président- Works, Inc, Winnipeg MB Expertise (Bâtiment), Dessau, Longueuil QC

William Carson

The commissioning process outlined in this workshop will address all disciplines in the construction process and their involvement and required participation.

Infection Prevention and Control Requirements During Healthcare Construction and Renovation – The ICP is Not the Enemy

Applications for Antimicrobial Properties Case Study – State-of-the-Art Water Distribution of Copper and Impact on Patient Safety System at Alberta Childrens Hospital and Subsequent Water Quality Research Harold Moret, Project Manager, Copper Development Association, New York NY

Post-Conference Workshop Commissioning of Healthcare Facilities

This course is intended to guide the participants through the complete commissioning process and will be based on the application of the new commissioning standard CSA Z 320 (Building Commissioning) including the application of the electronic web based commissioning check sheets. It will also address the special requirements for commissioning of healthcare facilities from CSA standard Z 318 (Commissioning of Health Care Facilities).

Therapeutic Design in Healthcare

Erin Haley-Stevenson, BAAID, ARIDO, NCIDQ, Associate, Parkin Architects Limited, Toronto ON Track 3

Best Practice in Healthcare

World Class Healthcare – US Perspectives - Dale Wooden, Executive Director, American Society for Healthcare Engineering (ASHE) Lynne Wilson Orr, BID, March, OAA, MRAIC, NCARB, ARIDO, Principal, Parkin Architects Limited, Toronto ON

Keynote Address

Senator Larry Smith

Codes and Compliance

Nick Stark, P.Eng., LEED AP, Vice-President Knowledge Management, H. H. Angus & Associates Limited, Toronto ON

Azad Chcihmanian, OAQ, AIA, RA (NY), OAA, RAIC, LEED AP, Architecte Associé, Partner, Montréal QC

Track 6

World Class Healthcare – International Perspectives - Mr. Gunnar Baekken, Past President, IFHE

Track 7

OR’s: What is done in Europre-Standards Vision Stratégique: des services techniques de class & Requirements mondiale

Track 8

Jean-Michel Vanhee, Clean Process Segment Manager, Camfil Farr/France, La Garenne-Colombes Cedex France

Serge Sevigny, Directeur des Services Techniques, Centre Universitaire de Santé McGill (CUSM). Montréal QC

Infection and Climate Control Possibilities for Construction of Health Care Facilities

Road to ISO

Bob Bedard, Gold Seal Superintendent 1995, Ellis Don Construction Services, Edmonton AB TJ Johnson, Vice President, Cavelier Industries, Edmonton AB Track 9

Exploring World Class Technologies for Healthcare Michel Methot, District General Manager, Quebec, Honeywell, Lachine QC

Track 10

Antonin Bouchard, Directeur Associé, Ingéniere et Opération, Centre Universitaire de Santé McGill (CUSM). Montréal QC Marc Dagneau, BA, UVIV & Power Engineer, BCIT, Technical Coordinator, Facilities Maintenance & Operations Manager, Fraser Health Authority, New Westminster BC Mitch Weimer, MA (Leadership), BA, Power Engineer, Director, Facilities Maintenance & Operations, Fraser Health Authority, New Westminster BC From 9 – 1 With the Help of Lean: The Development of Alberta Health Services Facilities Maintenance and Engineering Division Steve Rees, CFM, Vice President, Capital Management, Alberta health Services, Edmonton AB

World Class Healthcare – Québec Perspectives – Pierre Gauthier, Directeur de l’expertise et de la normalisation, Ministère de la santé et des servicessociaux, Quebec QC